Tag Archives: healthcare

America’s mental health disparities

By Bethany Bray December 10, 2018

Mental health care availability and access vary tremendously depending on where you live in the United States. In Massachusetts, for example, there is one mental health care provider for every 180 residents. That ratio is far different in Texas and Alabama, however, where there are more than 1,000 residents for every one provider.

Mental Health America (MHA) recently released its annual report of mental health indicators across the U.S. For the ratios above, MHA included counselors, psychiatrists, psychologists, licensed clinical social workers, marriage and family therapists, and nurses specializing in mental health care in its categorization of “mental health provider.”

MHA ranked Massachusetts as the best state for mental health care availability, followed by the District of Columbia, Maine, Oregon, Vermont, Oklahoma, New Mexico, Rhode Island, Alaska and Connecticut. All of these states and the District of Columbia have fewer than 300 residents per mental health care provider.

On the other end of the spectrum, Alabama (with 1,180 residents for every one provider) and Texas (1,010:1) were the lowest-ranked states, along with West Virginia (890:1), Georgia (830:1), Arizona (820:1), Mississippi and Iowa (760:1), Tennessee (740:1), and Florida and Indiana (700:1).

Although Oregon was near the top of MHA’s list for mental health care availability, it also ranked highest for prevalence of mental illness among adults. Nationwide, 18.07 percent of adults – or more than 44 million people – have a mental illness, defined as “a diagnosable mental, behavioral or emotional disorder, other than a developmental or substance use disorder.”

See MHA’s full report, “The State of Mental Health in America 2019,” at mentalhealthamerica.net

In Oregon, that prevalence was 22.61 percent, followed by Utah (22.27 percent), Kentucky (22.08 percent), Idaho (21.62 percent) and Arkansas (21.02 percent). West Virginia, Vermont, Washington, Montana, Colorado and Alaska followed with rates that were between 20 and 21 percent.

States with the lowest prevalence of adult mental illness included New Jersey (15.5 percent), Hawaii (15.55 percent), Illinois (15.73 percent), Texas (16.04 percent) and Maryland (16.59 percent). North Dakota, California, Florida, Louisiana, Michigan, Mississippi, Arizona, New York, Maine, Delaware, Iowa, Georgia and South Dakota all had rates between 17 and 18 percent.

MHA, a Virginia-based nonprofit advocacy organization, compiles a report titled The State of Mental Health in America each year from nationwide survey data, including information from the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention. Released this fall, MHA’s current report includes statistics on access to mental health care, uninsured citizens, rates of substance abuse, suicide indicators, youth depression and other factors.

See MHA’s full report, “The State of Mental Health in America 2019,” at mentalhealthamerica.net

 

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Mental Health America’s The State of Mental Health in America 2019

When it comes to mental health, how does your state stack up?

View the full report and state rankings at mentalhealthamerica.net

 

See MHA’s full report, “The State of Mental Health in America 2019,” at mentalhealthamerica.net

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Bringing CBT into the doctor’s office

By Bethany Bray September 12, 2018

When you get your annual physical, does your primary care physician ask if you’ve been feeling atypically sad or anxious lately?

Primary care doctors are often the first professional a person will tell about symptoms related to depression or other mental health issues. With this in mind, two Pennsylvania counselors have created a presentation on coping skills and takeaways from cognitive behavior therapy (CBT) that medical doctors can use with their patients.

When Brandon Ballantyne and Kevin Ulsh spoke to the primary care physicians and other medical personnel at Tower Health in Reading, Pennsylvania, recently, they found an interested and engaged audience. The medical practitioners were particularly interested in learning more about how to help patients who present with anxiety and related problems during medical appointments.

Ulsh and Ballantyne are mental health therapists in the inpatient and partial hospitalization programs, respectively, at Reading Hospital, which is part of the Tower Health system. Ballantyne is also a licensed professional counselor and American Counseling Association member.

How can aspects of CBT be translated for use in the medical professions? CT Online asked Ulsh and Ballantyne some questions to find out more.

 

How did this come together? Did you reach out to the doctors, or did they invite you to come?

We have always been interested in the concept of extending coping skills practice and implementation into primary care settings. We believe that the primary care setting is where most individuals first report problems associated with anxiety, stress, depression and so on. In many situations, the primary care physician is the first provider to address such issues.

Recently, we have observed a growing trend to integrate primary care and behavioral health services. We decided to take these observations and build a coping skills lecture that can assist providers in the primary care setting with addressing stress and anxiety, along with other mood-related problems with the patients they serve. We developed an outline for a presentation and broadcast the idea to the primary care Tower Health continuing education team, who then gave us an invitation to present it as a part of their lecture series.

 

How did it go? Were the doctors open to your message? What were some of the things they asked or commented about?

The lecture went well. The doctors in attendance were attentive and interested. They asked several questions about how to address behaviors particularly associated with adolescent anxiety such as school avoidance and oppositional defiance. We addressed these questions by referring back to the cognitive model, which we highlighted as a foundation of our lecture.

We think it was important to have a discussion with the doctors about the clinical indicators of avoidance versus defiance. Utilizing a cognitive philosophy, we emphasized that avoidance typically shows itself as a behavior which prevents an individual from doing something that they would like to be able to do or would want to be able to do if not affected by anxiety. The anxiety that drives avoidance is typically a product of some anticipated fear. … The individual has cognitively come to the conclusion that the fear itself is an already established fact or guarantee.

Defiance, on the other hand, is a behavior that is driven by the desire to maintain control by resisting demands and expectations to comply with things that are simply undesirable. In other words, in the cognitive process that drives defiance, an individual may think, “If I don’t like it or don’t want to do it, then I don’t have to, and it doesn’t matter what anyone says.”

Therefore, primary care physicians may be able to get a better handle on what it going on with the patient, clinically, simply by asking about their thinking.

 

From your perspective, how could CBT be helpful in a medical setting? Please talk about why you chose to focus on CBT when you spoke to the doctors.

We chose to focus on cognitive behavior therapy when providing this lecture because CBT is an evidence-based approach that has been shown to be an effective form of treatment for multiple psychological problems across various populations. We believe that in the primary care settings, patients will benefit most from socialization to the cognitive model, so that they can gain a clear understanding of the difference between a thought and an emotion.

Once an individual understands the relationship between a thought, an emotion and a behavior, they acquire control over regulating their mood and reactions in a positive way. CBT-based skills are goal-oriented, problem-focused and able to be introduced and taught to individuals dealing with a wide range of psychological problems.

In the fast-paced primary care setting, brief psychological education and skills practice can be a piece of the treatment puzzle that not only addresses the emotional problems of the patient, but also offers skills that they can continue to utilize and benefit from outside of the office (such as deep breathing, sleep hygiene, behavioral activation, disputing cognitive distortions, thought journals, activity scheduling, etc.).

 

From your perspective, what are the benefits to this kind of collaboration? In other words, benefits not only for the professionals involved, but for the patients/clients too.

There are multiple benefits to this kind of collaboration. We believe that in most cases, the first call that patients make when they are not feeling well is to their family doctor. On some occasions, they are being seen by their family doctor for a physical health issue. However, in the midst of assessment, they may reveal an emotional problem or talk about a significant stressor that is causing psychological distress.

This is because for the most part, individuals attend treatment with a primary care doctor whom they trust. Maybe they have been seeing this doctor for most of their life. They have learned to confide in this doctor quite often. Therefore, they may be more open to acknowledging emotional problems within that office setting.

The type of collaboration that we facilitated reinforces the importance of integrating psychological education and coping skills practice into a primary care setting. For professionals, it improves the continuum of care and reduces the stigma of mental health problems. Ongoing behavioral health collaboration, and having a behavioral health component to primary care treatment, implies that psychological distress is a natural area of assessment which patients might otherwise be hesitant to acknowledge or discuss. In this way, patients can become more open to behavioral health support and more accepting of their need to seek outpatient therapy to further resolve symptoms.

 

What advice or tips would you give to counselors who might want to collaborate with medical professionals, like you did, in their local area?

We would suggest that mental health professionals in all parts of the country consider developing a presentation on one particular area of therapy and/or psychological education that you feel passionate about [and] which you also utilize with the clients you serve. The goal is to develop a component of that theoretical orientation that is applicable to a primary care setting. It has to be something that primary care physicians can utilize within the short amount of time that they have with their patients.

We found that in our lecture, doctors were most interested in the practical applications of CBT as it pertains to the acute management of anxiety. We assume that other helpful topics may be closely related to dialectical behavior therapy [and] concepts such as mindfulness, distress tolerance and opposite action.

 

Is this something you think that counselors could or should do more of? What did you learn through this process?

As a result of providing this lecture, we learned that primary care doctors are very much interested in behavioral health support and assistance. It seems as though there has been an increase of patients presenting to family physicians with emotional problems. The doctors that we spoke with were very thankful for the background on CBT and the skills practice that we provided. In fact, they practiced some of the skills with us.

It reminded us that regardless of the [health] profession, we all will be most effective [with] our patients if we are also taking good care of ourselves. Integrating behavioral health support, psychological education and coping skills practice into a primary care setting reinforces the importance of seamless multidimensional treatment, ultimately helping patients to receive effective care that addresses their physical and emotional needs, and offers the safety to accept the behavioral health treatment that they may otherwise be hesitant to pursue.

 

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Ballantyne and Ulsh can be contacted via email:

Brandon.Ballantyne@towerhealth.org

Kevin.Ulsh@towerhealth.org

 

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Related reading, from Counseling Today:

Integrated interventions

The counselor’s role in assessing and treating medical symptoms and diagnoses

When brain meets body

 

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Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Integrated interventions

By Laurie Meyers May 25, 2018

W hen people think about integrated care, they may imagine a mental health care professional (or two) working in the same building with a physician or other medical professional and following a mutual agreement to refer cases to one another as needed. Others might picture a specialized setting, such as a pain clinic or cancer treatment center, where mental and emotional health concerns are addressed in relation to the medical or physical issue. However, multidisciplinary integrated care teams can now be found in hospitals, outpatient medical centers and community mental health clinics. Professional counselors who operate in these settings say that working in concert with other medical, mental and physical health professionals is the best way to provide clients with whole-person care.

Integrated care facilities are often in medical settings such as primary care clinics, but this doesn’t have to be the rule. Sherry Shamblin is chief of behavioral health operations for Hopewell Health Centers, a group of nonprofit community primary care and behavioral health clinics with 16 locations in southeast Ohio. She helped to develop a system that features primary care facilities in which counselors can conduct brief behavioral interventions and centers that focus principally on mental health but also offer primary care resources.

Shamblin’s thinking is that clients who already are struggling to manage serious mental health issues are often too overwhelmed to seek medical care. “If you’re depressed, you don’t really take care of yourself,” says Shamblin, a licensed professional clinical counselor with supervision designation. “You’re not valuing self-care and taking care of your [physical] health.” In addition, many psychotropic medications have side effects such as weight gain, which can increase clients’ chances of developing diabetes and other chronic illnesses, she notes.

“When you physically feel better, your mood improves, your energy is better, [you] feel more like tackling things that seem overwhelming and your overall coping improves,” says Shamblin, a member of the American Counseling Association. “Although mental and physical [health] have been separated for a long time … [the division] is artificial. It’s all connected.”

Counselors at the mental health clinics ask clients at intake whether they have a primary care physician and, if so, who that person is and when the last time was that the client saw their physician. Counselors will also try to get clients’ permission to access their medical records. That way, counselors can work with clients’ physicians to help ensure that clients are getting the health care they need, Shamblin explains.

If mental health clients don’t have a primary care physician or only go when they are feeling really ill, the counselor talks to them about health and wellness and the importance of receiving regular checkups. “We try to help them view it [regular health care] as another component of staying well,” Shamblin says.

If Hopewell Health Centers’ clients don’t have a primary care physician but would like to start taking better care of their health, they don’t have far to go — the mental health care facilities have exam rooms and primary care providers on-site. Having these resources readily available not only makes it easier for clients to access health care but also allows them to receive it in a setting in which they already feel comfortable, Shamblin says. The counselor (or other mental health professional) and onsite primary care provider then become a team dedicated to maintaining the client’s physical and mental health.

In Hopewell Health’s primary care clinics, counselors (who are called behavioral health consultants, or BHCs) play several roles. In some cases, the BHC is brought in to help the client manage a chronic illness. For example, Shamblin says, a primary care physician might see someone whose diabetes or high blood pressure is not under control despite treatment. This would provide an opportunity for the physician or nurse to explain that they have a colleague on the team who might be able to help the patient with this struggle. They would then ask if the patient would like to meet with the BHC.

The BHC would then try to determine the factors that are keeping the patient from progressing. For instance, is the person not taking medicine consistently or not watching their diet? If treatment adherence is a problem, the BHC assesses whether patients are ready to change their behavior and, if so, works with them to set goals and offers ongoing support. If patients are not open to making a change in a particular lifestyle area — such as diet, for example — the BHC would work with them to identify another positive lifestyle change they could make, such as stopping smoking or getting more exercise, Shamblin explains.

In other cases, the BHCs working in the primary care clinics conduct brief interventions with patients. The primary care physicians screen patients by asking questions that assess for signs of depression or substance abuse. If the physicians get an answer that concerns them — perhaps a patient saying that they have been feeling overwhelmed or depressed, for example — they ask the patient whether they can bring in someone who might be helpful, Shamblin says. The BHC will then ask brief questions to help determine whether the patient needs intervention.

Sometimes patients feel better just being given the opportunity to have a short conversation about their worries, Shamblin says. In such cases, the BHC will ask if it is OK to check in with the patient the next time the person returns to the clinic. In some cases, the BHC will ask the patient to come back for a few brief counseling sessions. In other instances, the BHC determines that patients need more intensive mental health care and will refer them to the clinic’s mental health professionals who oversee long-term care, Shamblin explains. The BHC then becomes the liaison between the primary care and mental health providers and will check in with the patient periodically to see how the person is doing, she says.

Hopewell Health Centers was created in 2013 when two organizations, Family Healthcare Inc. and Tri-County Mental Health and Counseling Services Inc., merged in order to provide integrated care. Shamblin notes that the frequency of Hopewell Health Centers’ screenings and treatment of substance abuse has gone up with the introduction of the integrated care model. Some data have suggested that the area of Ohio where the clinics operate has the lowest depression rates in the state, she says.

Leading the way in integration

Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, is a leader in hospital and outpatient integrated care. Just ask ACA member Laura Veach, who explains that the Wake Forest system has moved beyond the concept of integrated medicine being simply “co-located” care. In fact, the system is so integrated that Veach, a counselor educator, is a full professor in the Department of Surgery in the Wake Forest School of Medicine, a position that Veach thinks may be unique. Veach is also the director of counselor training at Wake Forest Baptist Medical Center. Though affiliated with Wake Forest University, the center also works with other counselor educator programs.

Veach has played a crucial role in the medical center’s emphasis on integrated care. She says she feels particularly fortunate because she works with a group of surgeons “who get it and want the best for patients.”

“We [counselors] are embedded in the medical team,” Veach explains. “We started in surgery in the specialty of trauma surgery and began to test the feasibility of doing counseling and screening and intervention at the bedside and [then] became a training site. Now we include posttraumatic stress disorder [PTSD] intervention work, crisis intervention and grief and loss work with trauma patients who have suffered the loss of a loved one in a trauma incident that brought them to the hospital. That led to the pediatric trauma unit, where we work with families of children who are traumatically injured, as well as the children themselves.”

Counselors are also part of integrated care efforts in the facility’s burn center, which is one of the only certified burn centers in North Carolina. Those efforts include providing ongoing counseling sessions in the burn intensive care unit and the step-down unit. Wake Forest Baptist Medical Center has also expanded integrated care into medical inpatient units, where people come in for issues such as pancreatitis, infections, pneumonia and so on.

Wake Forest Baptist Medical Center has a system that scans medical records to help identify patients who might need counseling help. For instance, when patients come through the emergency room, nurses ask them about depression, anxiety, suicidal thinking or past suicidal behavior. Other patients may receive bloodwork that shows elevated blood alcohol content or urine drug screens. Veach emphasizes that these are not for legal use but to help the medical center provide better integrated care. Some people may have elevated liver enzymes, which can be a sign of alcohol abuse, she continues. The medical records also include the physician’s account of what the patient’s complaint is. The chart-scanning system analyzes all of this information to help identify and prioritize who the counselors and other mental health professionals on staff should see first, she says.

Counselors introduce themselves as part of the team to patients and let them know that they are there to support the patients’ recovery and health. They then ask if the patients are open to the counselor spending some time with them. The counselors are rarely turned away, according to Veach.

After reviewing informed consent and confidentiality policies with each patient, the counselors simply listen, Veach emphasizes. “We try to just be present with them, to not ask questions, to hear what they are struggling with,” she says.

Veach notes that most of the medical center’s patients have never been to see a counselor before. So the counselors and counseling graduate students who work on the integrated teams at Wake Forest Baptist Medical Center are essentially educating these individuals about what counseling can provide. They tell patients they are prepared to listen to whatever the patients most want to talk about or need help with.

“What we find most often is that people have a lot to share,” Veach says. “We’re not someone who’s coming to do something to them; we’re someone who is coming to be with them. They might say, ‘I really want to talk to my family about this, but they’ll worry.’ A counselor or addictions specialist can be there and not be judgmental.”

In the medical center’s trauma and burn units, counselors stay on the alert for signs of acute stress or PTSD in patients, Veach says. After being released from the medical center, patients return for medical follow-up visits for the next six months, and counselors continue to check in and evaluate their recovery during this time. In certain cases, the counselors set up extended mental health therapy sessions with patients (scheduled adjacent to their medical visits) or recommend that they see a trauma specialist, such as someone trained in administering eye movement desensitization and reprocessing therapy.

When Veach first started working in integrated care, it was common for surgeons to state that they didn’t need or want to know about patients’ emotional issues — they just needed to know how to repair individuals surgically. “In the past decade, we’ve seen a big shift to asking how do we more fully treat this person to help them have a better chance of healing and without experiencing more trauma,” Veach says. “I think more trauma surgeons [today] know that if we don’t address [these emotional issues] now, we’re going to see them here again.”

Many people undergoing medical treatment aren’t aware of the types of issues that counseling or addictions treatment can help them address, or they don’t know how to access those services themselves, so having counselors as part of the team at Wake Forest Baptist Medical Center is particularly valuable, Veach says. Counselors on staff can make recommendations and point patients toward other resources. For instance, Veach says, families may have been struggling for years to get a loved one into treatment for substance use; counselors on staff at the medical center can offer information on which addictions centers in the area offer family support.

In the trauma and intensive care units, the teams offer dedicated support time for families two days per week. Counselors are on hand during these times to offer snacks and encouragement, Veach says. The integration of mental health into the hospital also extends to support groups, including a weekly trauma survivors’ network, a family member support group and a peer-led burn survivors group, she adds.

Veach has been helping to implement brief intervention counseling services at Wake Forest Baptist Medical Center for a decade. As counseling services have expanded to be included in more and more of the center’s departments, she has been surprised at how receptive medical patients are to counseling. She says she has witnessed “a deeply heartfelt responsiveness” on the part of patients to being heard and understood. In addition, surgeons have begun to tell Veach how valuable counselors are to the team. They tell her they are heartened to see patients getting care from counselors that they, as surgeons, can’t provide themselves.

Putting people first

Marcia Huston McCall, a national certified counselor and doctoral student in counseling and counselor education at the University of North Carolina at Greensboro (UNCG), spent several decades in health care management before becoming a counselor. She worked in the finance department at Massachusetts General Hospital and then became the business director of several different departments in an academic medical center in Winston-Salem, North Carolina.

McCall, an ACA member, says she went into health care management as a means of helping patients. She thought her business acumen was her strongest skill set and her best way of contributing. Over time, however, she became convinced that the business side of health care was moving farther and farther away from helping patients. “Health care management got so corporate,” she says. “I felt separated from the patients, and I wanted to have that contact.”

McCall realized that the people part of her job was what she loved best and decided that a career shift into counseling would be a better fit. She entered the counselor education program at Wake Forest University and completed her practicum and internship hours in inpatient integrated care at Wake Forest Baptist Medical Center. UNCG also has a relationship with Wake Forest Baptist Medical Center, so McCall completed her doctoral internship there and continues to work at the center as a graduate assistant.

McCall has worked in both the outpatient clinic and the inpatient section of the medical center. She says it is crucial for counselors to be full members of the team by participating in rounds and team huddles. “Having the counselor as part of the team when all the patients are being discussed is really important because you’re not only offering perspective but also picking up on things that might be issues,” she says. “They’re talking about patients you might not see [in the outpatient clinic], but you can pick up on patients that you do need to see.”

“In inpatient, we screen patients ourselves, so we review all the new admissions to our floors and identify the patients we think [will] need our services,” says McCall, a member of ACA. If she notices a history of substance abuse or other mental health issues, McCall brings this up before rounds or in the team huddle.

McCall and the other mental health professionals at the medical center conduct brief assessments with patients for signs of substance abuse, depression, anxiety, suicidality and delusions. In some cases, they conduct brief treatment and perhaps even see the patient a few times, depending on the length of stay. McCall also refers patients for further psychiatric or substance abuse care if needed.

Counselors working in integrated care settings frequently need to use their skills to build rapport with patients. For example, a physician might see signs indicating that a patient has possible substance abuse issues and call a counselor in for an assessment. In many cases, patients will not have sought treatment for substance abuse previously and may have avoided acknowledging that they have a problem.

“We’re walking in, and they may not be very interested in talking about their substance issues, particularly with a stranger,” McCall says. “We have to approach resistant patients in an indirect way and try to understand what their issues are and what they want to do about them,” she explains.

In such instances, McCall says that she rolls with the resistance. Friends and family members have likely been asking these individuals to seek help, but the patients haven’t been ready to acknowledge that they need treatment. McCall validates their resistance by verbalizing the arguments they are making against getting help. She says these patients often respond to her validation by saying, “Yeah, but I really do need help.” She then asks them what they are willing to do to get that care. If these patients voice a desire to pursue substance abuse treatment, counselors at the medical center connect them with specialty resources outside of the inpatient or clinic setting.

“We help them find that treatment and do as much as possible to ensure they actually get there — that everything is set up,” McCall says.

Counselors serve as consultants for the medical team at Wake Forest Baptist Medical Center but also act as advocates for the patients, McCall says. A lot of bias still exists among medical personnel about mental health issues, she explains, so counselors are there to help ensure that patients are seen as human beings who have needs, no matter what they have been through.

Counselors may also get called in when a physician is questioning whether a patient might need psychiatric services. The medical center doesn’t have many psychiatrists on staff, so the physicians are hesitant to call them for a consultation if there is no need for immediate inpatient treatment, McCall explains.

By working in integrated care, McCall says she gets to be a kind of ambassador for the counseling profession. “I have the opportunity to work not just with physicians and nurses, but residents, medical students, pharmacy students and physician assistant students,” she says. “[I] really have the opportunity to interact with people who aren’t used to having counselors as part of the team.”

McCall would like to bring even more of the counseling perspective into integrated care. She contends that “behavioral health” is too narrow of a designation and believes that counselors should define their own roles and use terminology that is more appropriate to the counseling profession. McCall says she wants her team, as well as other medical personnel working in different integrated care settings, to be aware that professional counselors are not just behaviorists but also possess many other skills. For example, McCall envisions counselors having a central role to play in helping patients who have gotten a shocking diagnosis or who are struggling with the inherent vulnerability of being in the hospital.

McCall also cautions counselors entering the field to be aware that supervision in integrated care settings is rarely provided by other counseling professionals. It is vital for counselors to maintain their professional identity while operating within integrated care, she emphasizes, even if that means pursuing additional supervision outside of the integrated care setting. Receiving ongoing supervision when working in integrated care is critical because the work can be intense and overwhelming, McCall says. Peer support and supervision can help counselors deal with stress and avoid burnout, she concludes.

Training students in integrated care

Some counseling students interested in integrated care are adding medical knowledge to their counseling skills. Rachel Levy-Bell, assistant professor of psychiatry and associate program director and director of clinical training in the mental health counseling and behavioral medicine program at Boston University School of Medicine (BUSM), teaches and trains counseling students to work in integrated care. The program at BUSM focuses not just on counseling but also behavioral medicine, so students take integrated care courses, learn about psychopharmacology and human sexuality, and get bedside training in getting to know the patient beyond the disease, says Levy-Bell, a member of ACA. She supervises practicum and internship students working in Boston University-affiliated clinics and other Boston community centers.

As part of practicum, Levy-Bell trains small groups of counseling students to conduct biopsychosocial interviews. Each week, the 10-member group receives a list of patients and their medical issues. As the counseling students visit the patients, they take turns being the lead interviewer. Students ask patients about what brought them to the hospital and deduce whether they fully understand their condition and how their disease affects their lifestyle, relationships and work. They also ask how patients physically manage their disease, how they cope with its demands and whether spirituality or religion plays a role for them. They also assess for substance abuse.

At the end of the interview, Levy-Bell asks the patients how they felt the students performed. Many patients share that they like that the students spent more time with them than the medical personnel typically do and also comment that the students are better at maintaining eye contact with them when talking and listening. Afterward, the group goes back to class to evaluate and discuss the interviews: What went right? What do they need to improve? What did they learn?

Part of the training process is getting counseling students used to working in medical settings and grappling with issues such as how to build therapeutic rapport when the patient has a roommate or when medical equipment is everywhere and beeping noises are constant, Levy-Bell says. Students are also exposed to things that they’ve never seen before. These experiences might make them uncomfortable, but they have to learn to control both their verbal and nonverbal reactions to ensure that they aren’t indicating discomfort, she says. Levy-Bell also focuses on practical aspects such as teaching students not to faint — or, at a minimum, fainting away from the patient. She also teaches students to wear light clothing (hospitals are hot), to stay hydrated, to make sure they eat and to take a break if they feel unsteady — but to always come back.

Sara Bailey, an ACA member who works at Wake Forest Baptist Medical Center as part of her postdoctoral fellowship, says that regardless of whether counselors plan to go into integrated care, working in a behavioral health setting provides excellent training. In integrated care, counselors-in-training get the chance to see how other professionals such as doctors, nurses and other mental health practitioners work and handle challenges, she says. They also quickly become aware that all practitioners encounter individuals with alcohol or substance abuse problems.

“In a perfect world, this would be required,” Bailey says. “You get to hone your reflection and rapport-building skills and have to learn to do your best in a short amount of time.”

 

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Podcasts (counseling.org/knowledge-center/podcasts)

  • “Integrated Care: Applying Theory to Practice” with Russ Curtis & Eric Christian (HT030)

ACA Interest networks (counseling.org/aca-community/aca-groups/interest-networks)

  • ACA Interest Network for Integrated Care

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Stepping across the poverty line

By Laurie Meyers May 26, 2016

According to a study by the U.S. Census Bureau, there were 46.7 million Americans living in poverty in 2014, or a poverty rate of 14.8 percent. The picture was even bleaker for many ethnic and racial minorities. The same study found that 26.2 percent of African Americans (10.8 million people) and 23.6 percent of Hispanic Americans (13.1 million people) lived in poverty. Children were also particularly vulnerable. The study reported that 21.1 percent of Americans under the age of 18 lived in poverty.

What qualifies as living in poverty? The answer is not simple. A number of factors are involved in calculating income, and the Census Bureau has created 48 possible poverty thresholds. Broadly, however, any single individual younger than 65 with an income of less than $12,316 or any single individual 65 or older with an income of less than $11,354 is considered to be living in Branding-Images_povertypoverty. The poverty threshold for two people under the age of 65 living together is $15,934, and the threshold for two people over the age of 65 living together is $14,326. For a family of three — one child and two adults — the threshold is $19,055. For a family of three with one adult and two children, the threshold is $18 higher at $19,073.

The thresholds are derived using the Orshansky Poverty Thresholds, a formula originally developed in the 1960s by Mollie Orshansky, an economist working for the Social Security Administration. The formula compares pretax cash income against a level set at three times the cost of a minimum food diet in 1963 in today’s prices (updated annually for inflation using the Consumer Price Index).

However, these numbers can’t truly capture the reality of daily life for those living under the strain of poverty, say counselors who regularly work with client populations that are economically disadvantaged. Imagine taking multiple buses and dedicating up to two hours of travel time to get someplace that someone who owns a car can reach in 20 minutes. Imagine having to choose between buying groceries or paying the electric bill. Imagine managing a chronic illness while living on the streets.

Counselors are trained in diversity and multiculturalism, but does this awareness of discrimination and alternative worldviews necessarily include those living poverty? Not often enough, asserts Pam Semmler, a licensed professional counselor (LPC) and private practitioner in Denver. “I’ve been to a lot of diversity trainings, and none of them covered socioeconomic barriers,” she says.

The average counselor doesn’t have adequate training or even a good frame of reference when it comes to clients living in poverty, says Semmler, who spent more than nine years counseling clients at the Colorado AIDS Project. The project is part of the Colorado Health Network, a statewide organization that provides health services, case management, substance abuse counseling, housing assistance, transportation, nutrition services and financial assistance to people with HIV and those at risk. Semmler has also provided training to staff at the Colorado Coalition for the Homeless on diversity issues specifically related to working with those in poverty.

Of course, people living in poverty are not one monolithic culture, Semmler stresses. However, they do share something deeply significant: a lack of money and limited access to the resources that money typically makes available.

“Poverty is actually a lack of multiple resources,” Semmler says. Financial resources are the most obvious, but those living in poverty also often lack health, housing, social, family, emotional and sometimes even spiritual resources, she continues.

To help clients living in poverty, counselors first need to understand the barriers that these individuals face in their everyday lives, say Semmler and other experts.

A different world

“We tend not to talk about a ‘culture of poverty’ as in years past,” says Louisa Foss-Kelly, a professor in the Counseling and School Psychology Department at Southern Connecticut State University whose research interests include counseling people who are economically disadvantaged. “However, people living in poverty often share perspectives and engage in similar survival-related activities. They do whatever it takes to meet their needs or those of the family’s.”

“For example,” she continues, “a client may sell belongings on the street to make some quick cash, barter services with neighbors and find other creative ways to pay bills that might not be understood by people in the middle or upper class.”

Because counselors often come from middle-class backgrounds, the practice of counseling often reflects those experiences and values, but practitioners should take care not to judge clients through this lens, says Foss-Kelly, an American Counseling Association member and LPC who has worked in community counseling settings with clients living in poverty.

“Unfortunately, many counselors have never been challenged to explore their own biases about poverty,” she says. “They may not understand the impact of their own socioeconomic history on the process of counseling.”

Counselors simply aren’t trained in the realities of living in poverty as part of their counseling education, says Victoria Kress, an ACA member and past president of the Ohio Counseling Association whose research interests include working with client populations that are economically disadvantaged. “For example, I was trained as a counselor in the early 1990s, and my training was based on middle-class values and assumptions,” she says. “It was assumed that my future clients would come in for counseling of their own volition; they would have food in their bellies; they’d be safe; they’d be verbal and forthcoming; they’d have transportation; they’d be invested in growing and living up to their optimal potential. As I began to see clients, it became increasingly clear that none of these assumptions was accurate.”

“People living in poverty engage in a constant financial battle,” Foss-Kelly adds. “They may have to work two or three jobs, find food banks and navigate the maze of social services organizations. They may struggle with children in emotional distress because of frequent moves or other family disruptions. These clients may arrive to counseling tired, hungry or late. A judgmental counselor might say that [these clients aren’t] serious about changing or that they’re too disorganized or lazy to take care of themselves.”

Chelsey Zoldan, an LPC, currently works as a counselor at the Medication Assisted Treatment Department at Meridian HealthCare in Youngstown, Ohio. But she has also counseled those in the rural Appalachian section of the state and says that time issues — mainly clients not having enough of it and being late to appointments — were among the most common obstacles.

Many clients living in poverty have unreliable transportation or no transportation at all, Zoldan points out. In some states, public agencies may provide transportation to community clinics and other services for those living at or below the poverty line, but there is no guarantee that transportation will be timely, she continues. Some clients rely on rides from friends and family, but the person doing the driving sets the schedule, which may not fit with the client’s needs. In other instances, friends and family members may not be reliable when it comes to promises to drive or offer other assistance, she says. Public transportation may not be readily available or may require multiple transfers on a sporadic schedule.

Zoldan, an ACA member, points out that it may take clients relying on area bus service two hours to get somewhere that it would take her 20 minutes to drive to in her car. She adds that the bus schedule is inscrutable to her and her colleagues, but that clients who are struggling to get by financially routinely navigate the inconsistent routes and take multiple buses to get where they need to go. Unfortunately, as a result, they are often late or even miss appointments altogether. “Some counselors might interpret this as meaning that they [the clients] don’t care or aren’t committed to the process,” Zoldan says, acknowledging that she had to shift her own perspective regarding timeliness when she first started working with clients who were economically disadvantaged.

Some health care and other service providers may not be willing to accommodate these scheduling challenges, and that is a problem, Zoldan says, because these clients still need to be seen. And if a provider turns them away after they are late in arriving, they may not come back at all, she points out.

Clients who are economically disadvantaged may also have limited work flexibility or lack child care, adds Kress, who is the community counseling clinic director, clinical mental health counseling program coordinator and addiction counseling program coordinator at Youngstown State University in Ohio. Counselors need to be sensitive to the logistical problems that these clients face, she says.

When possible, Kress says, practitioners should consider providing in-home counseling and flexible or drop-in scheduling. In addition, clinics or practices that have the resources might consider offering day care and transportation assistance, which could involve providing the actual transportation or giving out public transportation vouchers, Kress says.

Meeting basic needs

As Kress began her counseling career, she realized that many of her clients living near the poverty line were struggling simply to survive. This reality often required her to be more “active” in these clients’ lives than her training had prepared her for.

“One of my first clients — a teenage mother — came [to counseling] in crisis because her electricity had been turned off,” Kress remembers. “In that situation, what she needed from me was to help her figure out how to get it turned back on. Having never had my electricity turned off, I had no idea where to begin. And my counseling textbooks didn’t talk about how to get one’s electricity turned back on. I had to put aside my expectations, be flexible and roll with helping her problem-solve her electricity situation.”

Before counselors can begin to effectively address traditional counseling concerns, they must make sure that their clients’ basic survival needs — including food, shelter and clothing — are being met, say the professionals interviewed for this article.

In doing so, counselors working with clients in poverty may find themselves playing many different roles, says Zoldan, who is also a doctoral student in the counseling program at the University of Akron. “You might have to be care coordinator, do case management, perform vocational counseling,” she says. “You might also … help with county health funds, student loans, transportation.” Counselors might also serve as de facto mental health educators for their clients, their clients’ families and even the community at large, particularly in rural settings, Zoldan adds.

Some might think that many of these services are the purview of social workers, not counselors. But Kress has a message for those who protest this expanded vision of meeting the needs of clients.

“I’d say this: How can a person work on higher order counseling goals if they are worried about where their next meal is coming from or how they will get their electricity turned back on?” Kress says. “Effective counselors are flexible and meet their clients where they are at.”

Foss-Kelly agrees. “Counselors treat the whole person in context,” she emphasizes. “So we have to acknowledge and respond to the crises our clients face when they leave the counseling room, even if those crises are financial in nature. Counselors are well-trained to provide referrals and work alongside social workers. In addition, we have to integrate the client’s basic needs into case conceptualization, treatment and treatment planning.”

Kress adds that she believes it is “old-school thinking” to state that counselors shouldn’t also help clients with their basic needs. In fact, she says, in the area of community mental health, the days of clients being assigned to a case manager who was a social worker and then to a separate counselor are long gone. “Now what we see is clients being assigned one mental health professional who provides counseling and case management. The system has had to adapt to the needs of consumers.”

Although counselors in community clinics or facilities affiliated with local social services might more commonly work with individuals living in poverty, Kress and others interviewed for this article say that most practitioners will encounter clients who are economically disadvantaged at some point.

Zoldan urges counselors to be deliberate about ensuring that these clients feel empowered in their own treatment. Taking an authoritative approach as the counselor and neglecting or diminishing the client’s input is potentially detrimental, she points out. The counselor might very well be unaware of the individual’s basic needs that are going unmet, she says, and the client may not trust the practitioner at first because he or she is viewed as an outsider. “The goal is to collaborate with your client on everything,” Zoldan says. “People in poverty are used to feeling oppressed in different ways.”

“Many people who live in poverty perceive that existing institutions do not serve their interests and needs, and counselors need to recognize that they are part of the system, whether they like it or not,” Kress adds. “Counselors must be flexible and sensitive to clients’ needs.”

Because counselors are part of the system, they should work it to their clients’ advantage, say Zoldan and Kress. It can be important for counselors to align with agencies, clinics or charities that offer assistance with food, housing, health care and other needs, Zoldan points out. She urges counselors to build relationships with these organizations and to also make contacts with officials in local service agencies such as job and family services so that clients’ needs can be better met.

Seeking solutions

In addition to the challenges related to basic survival, those living in poverty face many other barriers, Kress says. Common issues among this population include substance abuse, chronic mental or physical illnesses, teenage pregnancy and unsafe living environments that might involve intimate partner violence, she explains.

“In my experience, clients need to have counselors acknowledge and validate their experiences,” she says. “Many times, clients may not even connect the dots that these experiences are having a significant impact on their lives. In many ways, these experiences have been such a part of the landscape of their lives that they don’t recognize the impacts they have on them.”

Semmler agrees, saying that many of her clients have never had anyone explain to them how poverty has affected the entire trajectory of their lives.

Those in poverty are often blamed for their circumstances and stereotyped as lazy or incapable of saving money, Zoldan says. The reality is that many of these individuals are working two or even three jobs just to scrape by and aren’t saving money because they don’t have any to spare, she says.

“Each day may start with managing different crises — trying to find food or a place to sleep or meeting other basic needs of the family,” Foss-Kelly observes. “This survival focus inevitably impacts both the content and process of any counseling session. A person-centered approach is a critical foundation for counseling, but it may move at a pace that’s too slow for addressing crises of survival.”

Adds Kress, “When working with these populations, counselors need to be active, involved and focused on concrete and present solutions.”

Several of the counselors we spoke to emphasized the need to help these clients recognize and build on the strengths they have already developed to survive under the strain of poverty. As with any client, counselors should take into account the worldview and individual context of a person living in poverty, says Zoldan, who likes to use strength-based counseling, particularly for those coming from generations of poverty.

Contrary to the stereotype of lazy people just looking for a handout, living in poverty actually requires a significant amount of self-sufficiency, Zoldan points out. These clients typically must navigate public transportation and assistance systems and may juggle multiple jobs with child care and other family responsibilities, all of which requires a great deal of planning, she notes. Zoldan recalls a former client who had a backup plan for any major eventuality, including what to do if she couldn’t pay her rent, couldn’t afford food, lost her primary means of transportation and so on.

Kress notes that those affected by poverty may also acquire skills and strengths — including the ability to accept and handle difficult situations and live in the moment as needed — that aren’t readily apparent to most casual observers. “Identification and expansion of client and client-system strengths help to provide hope and support clients’ well-being,” she says.

In general, people who live in poverty also strongly value relationships, Zoldan says. This can oftentimes be very positive. For example, friends and family members can provide the person both emotional and practical support in the form of child care, meal sharing, housing and so on.

However, in some cases, it can also erect another barrier, Zoldan says. “Relationships are valued above all else,” she observes, meaning that counselors need to be aware that getting these clients to set boundaries or remove themselves from unhealthy living situations can be a complicated proposition.

Simply telling a client to cut off a relationship is not culturally appropriate, Zoldan says, so counselors may need to encourage other alternatives. For instance, if a client is struggling with substance abuse and her mother and sister are still using in their homes, a counselor might suggest that, rather than cutting off all contact, the client and her relatives talk only by phone or meet in public instead of in the relatives’ homes.

Ending or limiting these relationships with family and friends represents a significant loss of connection for clients. So Zoldan and her colleagues encourage these clients to get involved in 12-step programs in which they can get support and build a family of sorts within the recovery group. Zoldan’s agency also encourages group therapy, which can offer another source of connection and support for clients living in poverty.

Semmler is an attachment-focused therapist, so she always circles back to relationships. “When people attach in order to survive, the relationships are not always the most healthy,” she observes. Becoming psychologically healthy may require clients to break some of those ties, so Semmler, during her time with the AIDS project, would encourage clients to make healthy attachments to service providers and other participants in the program.

Helping the youngest living in poverty

Children living in poverty face many challenges that make it difficult for them to get an education, says Christi Jones, an ACA member who is an elementary school counselor in rural Alabama. The board of education for her school district is trying to remove one significant barrier by matching students who are in need of psychological assistance with mental health counselors. Part of Jones’ job is to help facilitate this process.

“At my school, mental health services are provided one day a week,” Jones says. “As a school counselor with approximately 600 students, collaboration with our local mental health agency assists in meeting student needs. At the beginning of each school year, I introduce the mental health counselor to teachers and staff members and assist in developing a schedule. When coming from the outside to work in a school, it is essential to have an understanding of the school culture.”

“I work with the mental health counselor to build relationships with key staff members who can assist in success in the school setting,” she continues. “The mental health counselor in turn ensures I understand what is required for students to qualify to receive services in the school setting. I can then share information about the program with both teachers and parents.”

Jones explains that students in the rural area where she works often need help beyond what she can give them as a school counselor. Transportation is an issue for many of the children’s families, so having an in-house mental health counselor at the school eliminates that barrier and also provides a source of long-term support for children and their families.

Jones sometimes continues to collaborate with the mental health counselor to address a student’s difficulties. In addition, because the mental health counselor is at the school only one day per week, Jones sometimes sees students who need additional support.

Another equally important part of her role as a school counselor is to advocate for students’ overall well-being, which sometimes means helping to meet basic needs such as food and clothing, Jones asserts. “My mentor counselor told me during my first year as a school counselor that basic needs must be met before you can work on issues,” she says. “I provide counseling to my students, but I also believe that social justice is an important part of my role as a school counselor. I work to connect my students and their families to resources.”

It is hard for children to focus on learning if they are hungry or worried about where the next meal is coming from, Jones says, so she worked with church and community leaders to create a weekend backpack program. “Local churches come each Friday and provide backpacks of food from our local food bank for students to take home,” she explains. During the winter and spring school breaks, families are also given enough food to last until school starts again.

Jones also maintains a clothing closet stocked with various seasonal clothes for students in need. She doesn’t wait for these students to approach her before offering assistance.

“If you take the time to get to know your students, it is not hard to find out who is in need,” Jones says. “If they see you on a regular basis and you talk to them, they will share their struggles and successes with you. Also, I see things just by observing students in the halls or in their classrooms. Students will sometimes come to school in flip-flops in cold weather, or you can tell their shoes or clothes are too small. Teachers also provide information about student needs.”

“As the school counselor, I have had the opportunity to help many of the families in my community,” Jones says. “Where I work, it is small enough that you get to watch your students grow up. You know all the families, and you care about your students long after they leave your building. Beyond data, I measure success in graduation invitations and students coming back to tell me they are going to college. [They are] often the first in their family to do so. There are many challenges to working with students living in a rural, high-poverty area, but there are opportunities to make a difference that make it the most rewarding profession.”

Embracing counseling’s core values

The counselors interviewed for this story emphasize that clients living in poverty want help and want to be heard. “The most important advice I can give [to counselors]: Be authentic and be understanding,” Zoldan says.

To build a therapeutic relationship with clients dealing with impoverishment — or any client, for that matter — practitioners must fall back on the core values of counseling, says Almeta McCannon, an ACA member who co-led a roundtable session at the 2016 ACA Conference & Expo in Montréal on counseling people affected by poverty. “I would advise clinicians to go back to the cornerstones of our profession: empathy, compassion, unconditional positive regard,” she says. “These are what allow us to relate to people who have experienced things we could never imagine and still be able to help them through a difficult time or situation. Assuming is the enemy here. I would encourage [counselors to ask] questions about the things that they do not understand and to really listen to the responses to those questions.”

Foss-Kelly believes counselors also need to take the next step and advocate for those living in poverty. “Counselors can play a key role in advocating for the marginalized, including those in poverty,” she says. “Of course, this advocacy begins with individual clients and communities, but it should also include spreading awareness in professional circles and among power brokers. People living in poverty come to counseling in a vulnerable state. We as counselors must fight to help other counselors understand their unique needs.”

 

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To contact the people interviewed for this article, email:

 

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Additional resources

To learn more about the topics addressed in this article, see the following resources offered by the American Counseling Association.

Books (counseling.org/bookstore)

  • ACA Advocacy Competencies: A Social Justice Framework for Counselors edited by Manivong J. Ratts, Rebecca L. Toporek & Judith A. Lewis
  • Counseling for Multiculturalism and Social Justice: Integration, Theory and Application, fourth edition, by Manivong J. Ratts & Paul B. Pedersen
  • Multicultural Issues in Counseling: New Approaches to Diversity, fourth edition, by Courtland C. Lee

Webinars (counseling.org/continuing-education/webinars)

  • “Why Does Culture Matter? Isn’t Counseling Just Counseling Regardless?” with Courtland C. Lee

Podcasts (counseling.org/continuing-education/podcasts)

  • “Hunger, Hope and Healing” with Sarahjoy Marsh
  • “Multiculturalism and Diversity. What Is the Difference? Is Not Counseling … Counseling? Why Does It Matter?” With Courtland C. Lee

VISTAS Online articles (counseling.org/knowledge-center/vistas)

  • “Counselor Training and Poverty-Related Competencies: Implications and Recommendations for Counselor Training Programs” by Courtney East, Dixie Powers, Tristen Hyatt, Steven Wright & Viola May
  • “Preparing Counseling Students to Use Community Resources for a Diverse Client Population: Factors for Counselor Educators to Consider” by Sarah Kit-Yee Lam
  • “Professional Counseling in Rural Settings: Raising Awareness Through Discussion and Self-Study With Implications for Training and Support” by Dorothy Breen & Deborah L. Drew

In addition, counselors who would like to get involved in issues of diversity and social justice may be interested in joining Counselors for Social Justice, a division of ACA. Founded in 2000, CSJ’s mission is to work to promote social justice in society through confronting oppressive systems of power and privilege that affect professional counselors and their clients and to assist in the positive change in society through the professional development of counselors. Visit CSJ’s website at counseling-csj.org.

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

Medicare bill gains critical co-sponsor

By Bethany Bray November 23, 2015

U.S. Sen. Michael Bennet has agreed to co-sponsor a bill that would allow professional counselors to be reimbursed for care of clients who have Medicare health insurance, an issue the American Counseling Association has long advocated for.

The Colorado Democrat’s endorsement of the bill carries significant weight because he sits on the U.S. Senate Committee on Finance.

Bennet’s decision to co-sponsor the bill came after months of advocacy by American Counseling Association members in the Denver area. He is now one of 11 bipartisan lawmakers who co-sponsor the bill.

[Editor’s note: Soon after this article was posted, the bill gained another co-sponsor: Sen. Sherrod Brown (D-Ohio). As of December 2015, the bill has 12 co-sponsors.]

Senate bill 1830, or the Seniors Mental Health Access Improvement Act of 2015, would establish reimbursement of licensed professional counselors (LPCs) and licensed marriage and family counselors (LMFTs) for the treatment of clients whose primary coverage is Medicare, the federal

ACA member and LPCC Denise Magoto (on left) and LPC and licensed addictions counselor Katherine Bujak-Phillips are pictured at an advocacy to Sen. Michael Bennet's office this spring. Bujak-Phillips leads the LPC peer supervision group at the Medical Health Center of Denver, where Magoto works.

LPCC Denise Magoto (on left) and LPC and licensed addictions counselor (LAC) Katherine Bujak-Phillips are pictured at an advocacy visit to Sen. Michael Bennet’s office this spring. Bujak-Phillips leads the LPC peer supervision group at the Medical Health Center of Denver, where Magoto works.

health insurance program for citizens who are age 65 or older. Medicare has covered psychologists and licensed clinical social workers (LCSWs) since 1989, but does not cover LPCs.

“For years now we’ve ben hearing about the baby boomer generation coming onto Medicare. They’re already predicting shortfalls in healthcare, and mental health is no exception,” says Denise Magoto, an ACA member who has advocated for Bennet’s support of S.1830. “There’s not enough licensed clinical social workers to go around. We’re already seeing that shortfall.”

Magoto, a licensed professional counselor candidate (LPCC) at the Mental Health Center of Denver, is all too familiar with the headaches that counselors face over the Medicare reimbursement issue.

Every time a new client comes to the Mental Health Center of Denver, the intake department works to match the client with a clinician based on what insurance they have and whether or not the center would be reimbursed for their care.

“It really complicates the process,” says Magoto, who handles a caseload of clients with serious or persistent mental illness, often coupled with substance abuse.

The crux of the problem is that it keeps professional counselors from helping an entire slice of the U.S. population — more than 40 million people. Senior citizens are far from immune to depression, suicide and other mental health issues, Magoto notes.

Magoto has worked with the ACA government affairs team through the spring and summer to draw Sen. Bennet’s attention to the need for counselor reimbursement through Medicare. She has met with Priscilla Resendiz, a constituent advocate in Bennet’s office, twice; last month, Magoto gave Resendiz a tour of the center where she works.

Resendiz was “incredibly receptive,” Magoto says. When they met for the first time in May, what Magoto expected to be a 10-minute session stretched to an hour and a half.

Dillon Harp, grassroots organizer in ACA’s Department of Government Affairs, says local advocacy, like Magoto’s efforts, is critical for S.1830 to gain momentum and support.

“(Resendiz’s) visit and the tour were a huge success and it was instrumental in Senator Bennet co-sponsoring this important piece of legislation. Denise was able to highlight the important work that LPCs do and show the staff member why this bill must be passed,” says Harp, who attended Magoto’s meeting with Resendiz in October. “Getting Senator Bennet’s co-sponsorship was a major milestone in ACA’s efforts to get this bill passed. Obtaining Senator Bennet’s support was a crucial because of his seniority in the Senate and because he is a senior member who sits on the all-important Senate Finance Committee, which has jurisdiction over the Medicare program. ACA could not have secured Senator Bennet’s support without all the advocacy work that ACA members in Colorado performed.”

Bill S.1830 was introduced into the Senate on July 22 by Sen. John Barrasso (R-Wyo.) and co-sponsored by Sen. Debbie Stabenow (D-Mich.). After its introduction, the bill was referred to the finance committee; It won’t go for a full Senate vote until more co-sponsors support the bill, says Harp.

One lesson Magoto says she’s learned through this process is to never think that your hands are tied, or that you can’t do advocacy work if you aren’t politically savvy. She admits she’s a novice when it comes to the intricacies of government. Magoto simply knew there was a problem that was affecting her daily work as a counselor and contacted ACA to see what could be done.

“Initially I had some fear … The biggest thing that I’ve learned is that it (advocacy) is a learning process and that’s OK. It doesn’t mean you shouldn’t (advocate or get involved),” she says. “Even though I had no idea what I was doing, I had a resource [ACA] to reach out to and walk me through it.”

(Left to right) Katherine Bujak-Phillips, Priscilla Resendiz (constituent advocate in Sen. Bennet's office) and Denise Magoto.

(Left to right) Katherine Bujak-Phillips, Priscilla Resendiz (constituent advocate in Sen. Bennet’s office) and Denise Magoto.

 

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To get involved in ACA’s advocacy for the Medicare bill, and other issues that affect professional counselors, email Dillon Harp at dharp@counseling.org or visit counseling.org/government-affairs

 

To receive ACA’s Government Affairs newsletter and action alerts, email dharp@counseling.org

 

 

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Seniors Mental Health Access Improvement Act of 2015

Follow the bill’s progress at congress.gov: 1.usa.gov/1QysDjy

 

S.1830 co-sponsors (As of December 2015; listed in the order in which they agreed to co-sponsor)

Sen. Debbie Stabenow, D-Mich. (original co-sponsor)

Sen. Al Franken, D-Minn.

Sen. Kelly Ayotte, R-N.H.

Sen. Jon Tester, D-Mont.

Sen. Thomas Carper, D-Del.

Sen. Kristen Gillibrand, D-N.Y.

Sen. Charles Schumer, D-N.Y.

Sen. Susan Collins, R-Maine

Sen. Angus King, Jr., I-Maine

Sen. Richard Blumenthal, D-Conn.

Sen. Michael Bennet, D-Colo.

Sen. Sherrod Brown, D-Ohio

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

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